Background: Hepatocytes are the primary source of acetyl cholinesterase, which is released into the bloodstream and has a lower activity in liver dysfunction. Objective: The aim of this study was to assess the value of serum cholinesterase in early diagnosis of cases with liver cirrhosis. Patients and Methods: This study included a total of 111 patients with liver cirrhosis, attending at Internal Medicine Department, Zagazig University Hospitals and at Al-Ahrar Teaching Hospital. This study was conducted between April 2021 to October 2021. Patients were classified into 4 groups:1^st group: 24 Child A score liver cirrhosis cases, 2^nd group:25 Child B score liver cirrhosis case,3^rd group: 25 Child C score liver cirrhosis cases. And 4^th group: Matching control persons of a healthy 37 years old.Fibroscan and measurement of serum cholinesterase were done for all subjects. Results: The serum cholinesterase levels drop rapidly in each of the three cirrhosis grades, Child A, Child B, and Child C. In compensated cirrhosis, serum cholinesterase is higher than in decompensated cirrhosis. Blood albumin and cholinesterase levels were found to be strongly linked. Serum bilirubin and serum cholinesterase levels have a strong negative correlation. Patients with higher MELD scores have lower cholinesterase levels. Conclusion: It could be concluded that serum cholinesterase levels can help in liver cirrhosis diagnosis and prognosis. Serum cholinesterase concentration is strongly linked to the severity of cirrhosis.